P-wave and QT Interval Dispersion Analysis in Children with End Stage Renal Disease on Regular Hemodialysis

Objectives: The consequences of hemodialysis on P-wave dispersion and QT dispersion have not been unequivocally documented and understood and may be complex. To investigate homogeneity disorders of atrial conduction and ventricular repolarization and tendency to develop various arrhythmias by demonstrating the effects of hemodialysis in children with end stage renal disease through assessment of P-wave dispersion and QT dispersion (By electrocardiograghy).Methods:Twenty end stage renal disease patients on conventional hemodialysis for at least 12 months and twenty healthy, age and sex matched volunteers were included. Patients underwent echocardiography to exclude any abnormalities of cardiac valves or muscle. A 12-lead electrocardiogram was undertaken in order to measure minimal and maximal (P wave and QT interval) durations, P wave dispersion and QT dispersion.Results:In patient group, males were 13, females were 7 with mean age of 11.9 ± 3.4 years, mean P wave dispersion and QT dispersion were significantly longer than control group. P wave dispersion was significantly shorter after dialysis (mean= 34 ± 13.1 ms) than before dialysis (mean=42.4 ± 14 ms), whereas QT dispersion was longer after dialysis (59 ± 19 ms) than before dialysis (55.5 ± 17 ms) but the differences in QT dispersion was not significant. Also, there was no correlation between neither P wave dispersion nor QT dispersion and the electrolytes.Conclusion:P wave dispersion and QT dispersion was found to be higher in end stage renal disease children on regular hemodialysis than healthy control subjects, indicating heterogeneity disorders of atrial conduction and ventricular repolarization in these patients and tendency to develop various arrhythmias

Rheumatic fever runs in families: an old golden statement with recent echocardiographic proof

Since more that one-hundred years ago, Cheadle [1889] was the first to direct the attention that [Rheumatic fever runs in families]. This study was done to confirm this statement by Echo-Doppler for 62 families classified as: 28 families with index cases of R.H.Dand 34 families with only history of documented ARF. All family members of the two groups were investigated clinically, and by laboratory investigations to assess their rheumatic state i:e active or quiescent 4D and colour-flow echodoppler studies were performed for all the family members of the two rheumatic groups. An age matched control of 25 family members were also echo studied. The positive data obtained are the first study in the literature where 28.6% of the hearts of the fathers and mothers of the index cases with RHD are also affected, and the hearts of the first and second siblings are affected in 32.1% and 10.7% respectively. On the other hand, for the second group of families where the index cases had no cardiac pathology but only history of ARF, the percentage of valve affection of the fathers, mothers, and first sibling were 5.9%, 23.5% and 14.5% respectively. ARF: Acute Rheumatic Fever. RHD: Rheumatic Heart Disease. TNF: Tumor Necrozing Factor. 1FN: Interferon-gamma. IL: Interlukin. M.R: Mitral Regurgitation. A.R.: Aortic Regurgitation. M.V.P: Mitral valve Prolapse. M.S: Mitral Stenosis, GAS:Group A streptococci. C.B.C: Complete Blood Count. E.S.R: Erythrocyte Sedimentation Rate. C.R.P: C. Reactive Protein. A.S.O.T.: Antistreptolysin. O titer

Early predictors of neurodevelopmental outcome in neonatal bacterial meningitis

Neonatal bacterial meningitis [NBM] constitutes a major challenge for the increasing incidence and adverse outcome despite new tools in diagnosis and treatment. Neurodevelopment outcomes are the most severe and have to be predicted as early as possible in the course of the disease. This work aimed to study the contribution of some clinical, laboratory, electroencephalographic and ultrasonic procedures for predicting adverse outcomes of NBM, early in the course of the disease. This study included 45 full term newborn infants who were admitted to Neonatal Intensive Care Unit [NICU], Tanta University Hospital, with definitive NBM proved by cerebrospinal fluid [CSF] culture. All patients were subjected to thorough history taking, clinical examination, electroencephalography [EEG], cranial ultrasound Doppler as well as laboratory investigations including; blood culture, CSF culture, total leukocyte count, platelet count, plasma lactate, CSF lactate and CSF glutamate. All these procedures were fulfilled during the first week sf admission. Some cases were re-evaluated for EEG and cranial Doppler. Cases were followed for neurodevelopmental outcome for one year after discharge. The results showed adverse outcomes of cases of NBM at one year age. They revealed blindness, hemiparesis, microcephaly, cerebral palsy [8% for each one], seizures disorders [12%], hearing loss [16%] hydrocephalus [20%] and death [20%]. The most important clinical and laboratory predictors of adverse outcome were the presence of seizures duration > I2 hours [sensitivity 8804 and specificity 85%], coma at presentation [sensitivity 40% and specificity 95%], need for ventilator support [sensitivity 12% and specificity 95%], total leukocyte count <5000/ mm3 [sensitivity 36% and specificity 90%] and platelet count <10[5]/mm3 [sensitivity 40% and specificity 90%]. EEG results showed that EEG background activity and overall EEG description were identified as sensitive predictors of adverse outcome [sensitivity 88% and specificity 90%]. Elevated CSF lactate and glutamate were recorded to be sensitive predictors of adverse outcome [sensitivity 80% and specificity 95%]. Elevated plasma lactate recorded 60% sensitivity and 70%specificity as a predictor of outcome in NBM. Cranial Doppler was also proved a sensitive outcome predictor especially decreased regional cerebral blood flow [sensitivity 72% and specificity 90%] and increased pulsatility indices [sensitivity 80% and specificity 95%]

Conclusion: increased CSF levels of lactate and glutamate as well as presence of high pulsatility index by cranial ultrasonography provided the most useful information as early outcome predictors in NBM. EEG background activity and presence of seizures more than 12 hours came in the second degree in predicting adverse outcome. Interpretation of these sensitive clinical, laboratories, electroencephalographic and ultra-sonographic parameters may help in early prediction of the adverse neurodevelopmental outcome in NBM and may be of benefit in the rapid intervention and management of these cases especially in high-risk groups